Active NPI
Ardella Rae Martin, CASE MANAGER
- Case Manager/Care Coordinator
- Vincennes, IN
National Provider Identifier
1316061666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- PZ0691
- Practice address
- 1632 Busseron St
Vincennes, IN 47591-5550 - Phone
- (812) 895-0644
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | PZ0691 | IN | Primary |
Addresses
Primary practice location
1632 Busseron St
Vincennes, IN 47591-5550
Mailing address
1632 Busseron St
P.O.Box 1651
Vincennes, IN 47591-5550
Phone (812) 895-0644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200377980A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PZ0691 | IN | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222300800000",
"number": "1316061666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1632 BUSSERON ST",
"address_2": "P.O.BOX 1651",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475915550",
"telephone_number": "812-895-0644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1632 BUSSERON ST",
"city": "VINCENNES",
"state": "IN",
"postal_code": "475915550",
"telephone_number": "812-895-0644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "ARDELLA",
"middle_name": "RAE",
"credential": "CASE MANAGER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2008-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "IN",
"license": "PZ0691",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200377980A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vincennes, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.